Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Median sternotomy has been the accepted approach for dealing with mediastinal tumors or bilateral pulmonary disease, but exposure to the lower lobes and to mediastinal tumors extensively involving a hemithorax is often limited. Based on the reported experience from double-lung transplantation, we explored the use of clamshell incisions for these difficult problems. From March 1991 to December 1993, we prospectively studied the utility of clamshell incisions in 90 patients for the following indications: bilateral pulmonary metastases (62 patients), primary lung carcinoma with mediastinal involvement (13 patients), primary tumors of the mediastinum (14 patients), and mesothelioma (1 patient). Bilateral anterior thoracotomies with a transverse sternotomy (clamshell incision) were employed in 71 patients and a unilateral anterior thoracotomy with partial or complete median sternotomy (hemiclamshell incision) was used in 19 patients. For closure, we used pericostal sutures and sternal wires, usually augmented by sternal K-wire stents or Steinmann pins to prevent sternal override. Exposure to all areas of the mediastinum, pericardium, pleura, and lung was excellent. Specifically, the clamshell incision afforded markedly better access to lower lobe disease and hemithoracic extension of mediastinal disease than that possible with median sternotomy. There were no deaths or significant morbidity, and all patients tolerated the incisions well without mechanical respiratory difficulties. There was one wound infection. There was no late sternal override and the cosmetic results were found to be excellent during a follow-up of 2 to 33 months. We conclude that clamshell incisions constitute an improved surgical approach for the management of bilateral pulmonary or combined pulmonary and mediastinal disease.
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PMID:The clamshell incision: an improved approach to bilateral pulmonary and mediastinal tumor. 803 55

Malignant tumors of pleural origin are rare in childhood and difficult to diagnose. We report a case in a white 11 1/2-year-old girl who presented with a bulky tumour in the basal left lung field. There was an area of osteolysis at the ventral extremity of the 9th left rib allowing excision of the tumor by lateral thoracotomy. Macroscopically the operation was satisfactory. Despite two complementary excisions, chemotherapy with Vin-Caepi and consolidation chemotherapy followed by bone-marrow autograft, left pleural metastases appeared two years later. A second operation, a new course of chemotherapy with stage IV SIOP MMT, followed by a second bone-marrow graft and mediastinal radio-therapy, resulted in remission. At the time of this report, after three and a half years of evolution, the child's condition is satisfactory and she leads a normal life without treatment. A probable diagnosis of pleural mesothelioma was arrived at by elimination. This kind of tumour, without specific markers, is difficult to distinguish from small-round-cell tumors. Evolution is unpredictable and often rapidly fatal. Although these tumors generally have a weak response to chemo- and radiotherapy, we think that close follow-up and active therapy, rapidly initiated at the slightest sign, can improve the quality of life of the patients and increase their survival.
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PMID:Malignant pleural tumor in a child mimicking a mesothelioma. 811 Jul 20

A rare case of acute subdural hematoma due to dural metastasis from malignant pleural mesothelioma is reported. A 65-year-old man was brought to a nearby hospital complaining of lumbago. He suddenly complained of headache on the third hospital day and fell into a deep coma within a short while. Computed tomography showed a crescent shaped high density area in the right fronto-temporo-parietal region with midline shift to the left side. He was admitted as an emergency case to our clinic on April 24, 1989. Under the diagnosis of acute spontaneous subdural hematoma, emergency operation was performed. Nests of malignant sarcomatous cells were found in the clot obtained during the procedure, but the origin of the tumoral cells could not be identified. The patient failed to recover from the comatose state and died with pancytopenia on the 17th hospital day. General autopsy showed wide-spread malignant pleural mesothelioma with metastases to the lung, liver and bone marrow. Examination of the head revealed dural metastatic tumor and a subdural hematoma over the left hemisphere. Histopathology showed that many tumor cell nests were found only within the dilated veins of the dura. There, acute subdural hematoma was assumed to have developed suddenly and there was massive bleeding from the capillaries of the inner vascular layer of the dura. The relevant literature about intracranial metastasis of malignant pleural mesothelioma was reviewed, and the mechanism of subdural hematoma due to dural metastasis from malignant tumor was discussed.
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PMID:[A case of acute subdural hematoma due to dural metastasis from malignant pleural mesothelioma]. 813 66

We describe 12 patients with simultaneous bilateral spontaneous pneumothorax (SBSP). They represent 4 percent of patients with spontaneous pneumothorax seen at our hospital from 1971 to 1990. Five of the 12 had no underlying lung disease. In the seven remaining patients, SBSP was secondary to histiocytosis X, lymphangioleiomyomatosis, osteogenic sarcoma with pleural and pulmonary metastases, Hodgkin's disease, mesothelioma, cystic fibrosis, or miliary tuberculosis. Nineteen of the 56 patients with SBSP (34 percent) described in the literature (this series included) had pulmonary disease related to disorders of cells of mesenchymal origin. Emphysema and bullous lung disease were not associated with SBSP. Long-term prognosis was a function of pulmonary status. Four of the patients described herein died during the period reviewed. All suffered from severe underlying disease. In no case was SBSP the main cause of death. With timely treatment, the short-term prognosis is benign even for patients with underlying lung disease. Surgical pleurectomy should be attempted early, especially in SBSP secondary to underlying lung disease.
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PMID:Simultaneous bilateral spontaneous pneumothorax. 816 40

A spontaneous multicystic peritoneal mesothelioma was detected in a 108-wk-old male Fischer-344/DuCrj rat. Grossly, a tumor containing numerous, semi-transparent, variously sized, thin-walled cysts was found on the splenic serosal surface. Microscopically, each cyst was surrounded by variable amounts of loose connective tissue. The luminal and free surfaces of the cysts were covered by a single layer of flattened or cuboidal mesothelial cells. No metastases were detected in any of the other organs. Diagnosis was supported by immunohistochemistry and ultrastructural features.
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PMID:Multicystic peritoneal mesothelioma in a Fischer-344 rat. 837 10

Although intracranial metastases from malignant pleural mesothelioma are rare, their presence should be suspected in cases of high-grade mesothelioma and should possibly be included in routine preoperative evaluation. An unusual case of cerebral metastases from pleural mesothelioma is presented and the literature is reviewed.
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PMID:Intracranial metastases from malignant pleural mesothelioma. 864 36

The main pleural disorders are: effusion, thickening, masses and pneumothorax. Chest radiography is the first approach to evaluation of pleural disease; further evaluation is based upon ultrasounds (US), computed tomography (CT), and high-resolution CT (HRCT). The typical appearance of free pleural effusion is a homogeneous opacity with concave upper boundary; subpulmonic or intrafissural collections may also occur; the exudative effusions can be organized by adhesions between the pleural layers; consequently, loculated collections result. Radiographs allow us to assess the presence, amount and arrangement of effusions, but US and, especially, CT are needed to detect the modifications of the underlying pleura: circumferential thickenings, irregular and more than 1 cm thick are mostly malignant and denote mesothelioma or metastases: subtle and regular thickening is the typical appearance of fibrosis; a normal pleura does not exclude a malignant effusion. CT plays a major role in the diagnosis and management of empyema and in differentiating it from the pulmonary abscess. With CT it is also possible to differentiate the true pleural thickening from the false one due to a simple increase of extrapleural fat, and to disclose the activity of a fibrothorax through the detection of a small amount of fluid between the pleural layers. Pleural plaques are clearly visible by conventional radiography, especially with oblique views; US and CT are needed in the assessment of pleural tumors (fibroma, lipoma, fibro- and liposarcoma) and in determining the involvement of the lung and the chest wall. Pneumothorax is easily detected by conventional radiographs in the upright patient; when supine, the air collects in the anterobasal regions and particular projections are required; CT can reveal small amounts of air and is recommended in critically ill or trauma patients.
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PMID:Imaging of pleural diseases. 868 Mar 81

We report a case of malignant pleural mesothelioma in a patient who presented with pleural effusion and reticulonodular shadow on chest radiograph. Pulmonary metastases were diagnosed by transbronchial lung biopsy specimen and the patient died of extensive pulmonary metastases. This pattern of clinical and radiographic presentation is seldom reported for malignant pleural mesothelioma.
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PMID:Extensive pulmonary metastases in malignant pleural mesothelioma. A rare clinical and radiographic presentation. 868 49

In a series of 23 cases of mesothelioma of either the epithelial, sarcomatoid or the mixed type, the expression of three calcium-binding proteins (calretinin, parvalbumin and calbindin-D28k) was studied using immunohistochemical techniques on paraffin sections. The results show that calretinin is expressed in mesotheliomas of the epithelial type (papillary, adenomatous or solid) and by the epithelial component of the mixed tumours. The immunohistochemical reaction is specific and reproducible. The tissues of the pulmonary parenchyma and of the pleura are negative for calretinin except for the rare fibroblasts and some skeletal muscle fibres situated in the interstices of, or near the epithelial tumour mass. The sarcomatoid mesotheliomas and the sarcomatoid component of the mixed tumours do not express calretinin. Parvalbumin and calbindin-D28k are expressed neither in mesotheliomas nor in normal lung tissue. Primary adenocarcinomas of the lung are negative for all three calcium binding proteins cited. Thus, calretinin seems to represent a selective marker for mesotheliomas of the epithelial type and allows their differentiation from metastases of lung adenocarcinomas.
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PMID:The calcium binding protein calretinin is a selective marker for malignant pleural mesotheliomas of the epithelial type. 869 14

Twenty cases of ovarian carcinoma with normal-sized ovaries were examined histologically. Fifteen of them had metastatic disease of the peritoneal cavity and three of the remaining showed uterine involvement. Only in one case was the tumor confined to the ovary, but this patient had experienced systemic chemotherapy before surgery. The remaining case had metastasis of the stomach. Thus, "normal-sized" ovarian carcinoma has a great tendency to spread externally. Histology of the carcinoma was that of common epithelial carcinoma of the ovary with variable degrees of differentiation except for three cases of apparent ovarian metastasis. No cases of definite mesothelioma with ovarian involvement were encountered. A search for determinants of the peritoneal spread was performed using immunohistochemistry for p53 and bcl-2 proteins. However, no differences were found in the antigen expression between the group with and without peritoneal metastasis.
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PMID:Pathological aspects of normal-sized ovarian carcinoma. 875 May 10


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